Audits: Be a bit of a sleuth

Q. Is there any way to know what types of equipment/supplies are being audited before I get the dreaded audit notice?
Monday, February 22, 2016

A. Believe it or not, you don’t have to be a fortune teller to predict what Medicare and its auditors have on their radar, but being a bit of a sleuth won’t hurt. Let me explain.

Some audit contractors make it simple by publishing the types of DMEPOS they intend to audit on their websites. The RACs, for example, can only perform post-payment audits on codes approved by CMS. Once CMS has approved the codes, the RAC will post the information to their website in the “Approved Issues” table. The table lists the code or codes, type of review—automated or complex—and then the specific details of the review. Currently, the RACs are working from a contract extension through at least mid-summer 2016, which means that they are not required to post new issues to their respective sites. This, however, does not mean that they are not performing audits, but that any issues previously approved by CMS and posted are fair game. 

The SMRC also lists the projects they are currently working on to their website in the “Current Projects” section. The website also provides details for the projects in the form of applicable coverage policies and guidelines. 

The medical review departments of the DME MACs notify suppliers of upcoming reviews and also inform suppliers of ongoing reviews. Paying attention to the types of articles that are posted and reposted to the website is another way to anticipate audited codes. A review of the education events calendars of the DME MACs can also provide you with clues. 

Reviewing contractor websites on a periodic basis for the equipment you provide to Medicare beneficiaries may not be a foolproof plan in terms of audit protection, but it can leave you better prepared should you receive an audit notice.

Kelly Grahovac is senior consultant at The van Halem Group. Reach her at